CARE HOME ADULTS 18-65
Benjamin House 41 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
Mr Jeff Pearson Unannounced Inspection 9:45 15 & 28 March 2006
th th Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Benjamin House Address 41 Ormerod Road Burnley Lancashire BB11 2RU 01282 835926 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Bridget Mary Healy Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home will accommodate up to 10 adults up to the age of 65 years who have mental health problems 28th July 2005 Date of last inspection Brief Description of the Service: Benjamin House is part of Healy Care Dispersed Home Scheme which consists of three terraced properties. An additional property is used an office facility. The properties are situated on the same rood, in what is primarily a residential area. Benjamin House is close to the resources available in Burnley town centre, and is registered to accommodate 10 adults under the age of 65 with a mental illness. The accommodation available is homely and domestic in style. There is a lounge, designated room for smoking and a dining kitchen with conservatory area. There are six bedrooms (four with en-suite toilets) and two twin bedrooms. Work to further develop the accommodation is being carried out. Staff are on duty to provide support 24 hours per day. Transport is available to enable service users to visit relatives and for outings within the community. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took 12 hours and was carried out over two days by one inspector. The main focus of the inspection was to monitor progress in meeting/addressing the requirements and recommendations highlighted during the previous inspection. The house manager had been in post at the home for approximately 4 weeks. There were 8 service users accommodated. The files/records of 3 service users were examined as part of ‘case tracking’, this being a method of focusing upon a representative group of residents. The records of the most recently recruited staff were looked at. During the inspection, all service users, a relative, the house manager, registered provider and staff were spoken with. A tour of the premises was carried out. Some policies and procedures were looked at. Comment cards for service users and others were sent to the home. What the service does well: What has improved since the last inspection?
The guide to the home had been updated to provide better information for service users. The catering had improved, service users commented - “we get quality food now, it’s much better, there’s always fresh fruit around for us” “We get proper food its nice, not like the hospital” “We decide what we are having, we make our own meals at lunchtime” New floor coverings had been fitted in the hallway/passage which made the home look a lot better for the service users. Some more furnishings such as mirrors, light shades and shelving had been provided in people’s rooms which they really appreciated. The smoke room had been finished, this provided a more pleasant area for people; some had been involved in choosing a picture to go on the wall. More rooms had been made available for staff and the managers. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 The homes guide had been updated to provide more accurate and detailed information for service users. Initial assessment details were incomplete or not available, so it was not clear if peoples’ needs had been fully assessed or that they could be met at the home. EVIDENCE: The service user guide and last inspection report were readily available in the home. The guide included information to help prospective service users make a decision about choosing to accept a placement at Benjamin House. Service users spoken with said they had been given a copy of the guide. The guide was written in a formal style. One service user commented ‘it’s a bit boring and long’ Initial assessments were available in some service users files; others did not include this information. The house manager was not aware if assessment details were available for each person. There were no copy letters available confirming the home could meet service users needs. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 Systems were in place to enable service users to make decisions and choices, as individuals and as a group. Assessing and managing risk taking again needed further attention, to ensure a reasonable balance is achieved between independence, choice, rights and personal safety. EVIDENCE: The care planning process showed service users were being supported to make choices and decisions in their daily lives. Service users said house meetings were held each week, for group discussions and information sharing, they felt involved with day-to-day matters. Staff were seen to consult with service users about things which affected them. Risk taking was discussed with the house manager, including the need to ensure proper attention is given to each persons’ ability and clarifying support needs in response. Service users were observed to take risks as part of day to day living, for example some went into the community independently, but their were no risk assessments/risk strategies to cover this. Some risk assessments had been completed, others needed updating or defining in response to
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 10 individual circumstances. Risk assessments had not been completed on service users having access to hot water in their rooms. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 16, 17 Service users were being offered opportunities to engage in a range of activities, they were supported to use community resources. Independence was being promoted and rights were being respected, some rules needed to be agreed to clarify any limitations and responsibilities. The catering arrangements were sufficient in providing for the residents tastes, choices, diet and skill development. EVIDENCE: Service users spoke of the various activities, both in and out of the home, including clubs, college, project work, pubs, church, sports/fitness centres, shopping and TV, During the inspection some service users went out into the local community. Independence living skills were being encouraged, service users kept their rooms tidy and did their own laundry. Activity programmes showed involvement with chores in the home, but they were no linked with care plans so had not been properly agreed. The house rules were displayed in the home,
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 12 they had been written some time ago; some matters such as respecting others had not been included. Some agreed limitations had not been updated in care plans. Service users said they were happy with the variety and quality of the meals provided. Some were involved with shopping for provisions. Mealtimes were flexible, depending what was happening in the home. Service users made drinks and snacks for themselves and said they could get involved with cooking and baking. The service users said they were being asked each week about the choices for the evening meal. They said they could have whatever they wanted for breakfast and lunch. Records were seen of the meals served. Fresh fruit was available and healthy eating was being encouraged. Service users said better branded foods were now being purchased. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Support with personal care was provided sensitively in response to service users needs and wishes. Medication management practices were in need of improvement for the protection of the service users and staff. EVIDENCE: Service users personal care support needs were highlighted in their individual Plans as appropriate. Service users spoken with implied this support was provided sensitively and discreetly. People were being enabled to choose their own clothing and style of dress, with some support being given. The manager was not clear about the personal needs of one person; this matter needed further attention. Medication storage facilities were satisfactory. Individual risk assessments had been completed with service users on managing their own medication. Records were clear and up to date. The medication management policies and procedures had not been revised and updated to include current good practice. Only the house manager had received accredited medication management training, application forms were seen for a college based medication training
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 14 course. There was still no policy or individual protocols for when necessary or variable dose medication. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 No progress had been made in updating the protection and abuse policies and procedures; this may result in protection and abuse matters not being properly dealt with. EVIDENCE: The protection/abuse policies and referral procedures were still in the process of being revised and updated. The staff whistle blowing policy was also still being updated. Some staff had received guidance on abuse and protection as part of NVQ training, or the initial induction training programme. There had not been any staff training on protection and abuse matters or dealing with challenging behaviour. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, Some areas of the home were still in need of attention to improve the living environment for the service users. EVIDENCE: The There was no written programme of refurbishment or renewal. The homeowner had not provided written assurances to the Commission about improving the home. Most of the service users were happy with their rooms which were furnished to a good standard. Some had en-suite toilets. People had been supported to personalise their rooms with their own belongings. Additional furnishings had been obtained including mirrors and shelving. Bedroom doors were fitted with locks with most service users holding keys, lockable facilities were provided. Two of the bedrooms were still in a poor state and in need of upgrading. Work was ongoing to provide additional bedrooms with better facilities. The lounge provided a pleasant environment for the service users. The dining room/conservatory provided a useful space; a computer with Internet access was available. The room designated for smoking had been finished; some service users went out to choose a picture for this room. Additional office space and a staff area had been created. New floor covering had been fitted in the hallway/corridor.
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Staff training and development was ongoing, this needed to continue to ensure all staff are appropriately trained. Staffing arrangements were insufficient in providing appropriate support for the service users. Staff recruitment practices indicated full attention was not being given to protecting the service users. EVIDENCE: Observation of staff working with service users suggested positive relationships had been developed; staff seemed respectful and sensitive to the needs of the service users. Service users made some positive comments about the staff team, “I like it here, the people are nice” said one. Records were seen of the initial induction training for the most recent staff, who confirmed she had been interviewed and was being given training by the house manager. NVQ training and training in safe working practices was ongoing; three support workers were doing NVQ level 3. The house manger was undertaking NVQ level 4. Staff rotas indicated that on several occasions the house manager had covered support workers shifts, on one occasion working 70 hours in a week, another member of staff had worked 50 hours on a number of occasions.
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 18 Staff recruitment was ongoing within the organisation, but there were still not enough staff at Benjamin House. One service user commented “staff are always coming and going and there aren’t enough of them” There were not sufficient numbers of staff employed at the home to adequately cover for holidays and sickness. There was no longer a cleaner employed at the home, which meant support staff had additional duties. The records of the most recently employed staff had some required details missing, there was only one written reference, full employment history had not been obtained, and there were no explanations for gaps in employment. The medical declaration did not include sufficient information to make an informed judgement about health matters. The CRB (Criminal Record Bureau) checks were not readily available. The staff rota showed one of the home owners’ sons had been working alongside the waking watch night staff, but there were no staff recruitment records, or induction training records in respect of him. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 The management arrangements were in insufficient in providing continued stability, organization and direction for the service users and staff. Improvements were still needed to show the home was being properly reviewed and developed, with the involvement of service users and others. Policies and procedures to underpin a smooth running of the home for service users; remained insufficient in providing appropriate, up to date guidance for staff. EVIDENCE: Since the last inspection the homeowner had made changes in the management of Benjamin House, the previous manger had been moved to another home and her application for registration withdrawn. The current manager had recently transferred from another home in the organisation to Benjamin House. A completed application for registered manager had not been forwarded to the Commission. The house manager was enthusiastic and expressed commitment in providing a good service for the people living at
Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 20 Benjamin House, but due to the lack of staff, senior/deputy support, was unable to effectively manage the home. There was no job description for the manager clarifying expectations of the role. Service users meetings wee being held, but the house manager said she was not aware of any structured quality assurance systems; there was no annual development plan available. The policy and procedure file was available to the manger service users and staff, but remained unchanged. Risk assessments were available on safe working practices and the environment. Various records were available to show the servicing of equipment and installations. Records showed fire equipment was being tested and fire drills had been carried out, the house manager said fire safety training had been arranged. Seven staff and the house manager had attended First Aid training, only one member of staff had attended infection control training and only one had a Basic Food Hygiene Certificate. Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 1 1 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Benjamin House Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 1 2 X 2 X DS0000009525.V260473.R01.S.doc Version 5.0 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14,17 Requirement Records of service users initial assessments must be kept available in the home. (Timescale of 01/09/05 not met) Risk assessments/management strategies must be completed on service users engaging in activities which may affect their health or well-being. (Timescale of 01/09/05 not met) All staff responsible for dealing with medication must receive accredited medication management training. (Timescale of 01/10/05 not met) Medication management policies and procedures must be in accordance with current recognised guidelines and legislation (Timescale of 01/10/05 not met) The protection and abuse policies must be amended to include appropriate details for responding to suspicions, allegations, or incidents of abuse or neglect. Staff must be made
DS0000009525.V260473.R01.S.doc Timescale for action 05/05/06 2. YA9 13 12/05/06 3. YA20 13 07/07/06 4. YA20 13,17 12/05/06 5. YA23 13 12/05/06 Benjamin House Version 5.0 Page 23 6. YA24 16,23 7. YA26 12,16,23 8. YA33 18 9. YA34 17,19 10. 11. 12 YA35 YA37 YA39 18 8 24 13 YA42 13,23 aware of these procedures. (Timescale of 01/09/05 not met) The home must be refurbished to a satisfactory standard. (Timescale of 01/10/05 not met) All service users bedrooms must include the minimum furnishings as outlined in standard 26 of the National Minimum Standards for Younger Adults, unless otherwise agreed. (Timescale of 01/10/05 not met) Sufficient numbers of staff who are trained and competent to meet the needs of the service users, must be available to work in the home at all times. (Timescale of 28/07/05 not met) The recruitment practices must include the obtaining of required information for all staff. Full employment histories must be sought and records kept of gaps in employment. Two satisfactory written refernces must be obtained. CRB (Criminal Record Checks) must be readily available. All staff must undertake an approprite programme of induction training. A suitable manager must apply for registration with the Commission. A formal system for reviewing and improving the quality of care provided at the home must be implemnted. (Timescale of 01/10/05 not met) All saff must receive training in safe workin g practices, as specified in standard 42.2 of the National Minimum Standards for Younger Adults.
DS0000009525.V260473.R01.S.doc 28/07/06 12/05/06 12/05/06 05/05/06 05/05/06 05/05/06 26/05/06 21/07/06 Benjamin House Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA2 YA16 Good Practice Recommendations The service user guide should be produced in a more ‘user friendly’ version. Copies of letters to service users confirming the home can meet their needs should be kept on service users files. The house rules should be reviewed and agreed with the service users. Activity programmes should be referred to and agreed in service users individual Plans. New agreed limitations should be incorporated in individual plans as soon as possible. Clear criteria should be defined on an individual basis, when service users are prescribed when necessary and variable dose medication. All staff should receive training on protection and abuse and dealing with challenging behaviour. Staff should continue to be supported to undertake appropriate training, as specified by the National Minimum Standards for Younger Adults. The staff recruitment application form should be updated to ensure all appropriate details are recorded and responded to. The manager should be provided with a job description which clearly indicates designated duties and responsibilities, in relation to the Care Home Regulations and National Minimum Standards. Policies and procedures should be reviewed and up dated in line with current good practice and in accordance with Appendix 3 of the National Minimum Standards for Younger Adults. 4. 5. 6. 7. 8. YA20 YA23 YA32 YA34 YA37 9. YA40 Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Benjamin House DS0000009525.V260473.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
